Five Skills Your Brain Loses With Hearing Loss (And How to Get Them Back)
By Dr. Layne Garrett, Au.D., FAAA, ABAC, CH-TM, CDP (About | YouTube | Podcast | LinkedIn)
Date Published: March 23, 2026 3:30 PM MDT
You wear your hearing aids every day. At home, things are clear. But walk into a noisy restaurant and everything falls apart. You smile and nod, hoping nobody notices.
Quick Answer: When hearing loss goes untreated for years, your brain loses five key listening skills—processing speech in noise, following rapid speech, separating competing voices, holding sentences in memory, and filling in missed words. Hearing aids restore sound to your ears. But they don’t automatically rebuild those skills. That requires auditory brain training. We combine Real Ear Measurement-verified fittings with LACE-AI Pro brain training. You need both for real-world results.
I also cover this topic in a video—[VIDEO LINK]watch it here[/VIDEO LINK] if that’s more your style.
Are you a referring clinician? Skip to the clinical summary below.
In This Article
- Why Hearing Aids Aren’t Always Enough
- What Happens in Your Brain Over Time
- The Five Listening Skills I See Decline
- Your Foundation Has to Come First: Real Ear Measurement
- How Brain Training Actually Works
- How LACE-AI Pro Rebuilds Each Skill
- When Brain Training Doesn’t Work
- Hearing Care on the Wasatch Front
- Common Questions About Brain Training
Why Hearing Aids Aren’t Always Enough
Hearing aids don’t fix the problem. They manage it.
It’s a pattern I’ve watched repeat itself for two decades. A patient comes in frustrated. They spent good money on hearing aids. Their audiogram looks fine. Their devices test perfectly. But they still can’t follow a conversation at Sunday dinner. They still avoid loud events. They still feel exhausted after family gatherings because listening takes so much effort.
Here’s what I tell them. Your hearing aids are doing exactly what they should. The problem isn’t your devices. The problem is that nobody trained your brain.
This is the part most providers skip. It’s also why so many people with hearing aids still struggle in noise.
What Happens in Your Brain Over Time
Understanding how hearing aids work is a good start. But hearing aids only address half the problem.
When your ears stop sending clear signals to your brain, your brain doesn’t just wait patiently. It reorganizes. Research suggests that even mild-to-moderate hearing loss is associated with measurable changes in how the brain processes sound—including shifts in auditory cortex activity and increased recruitment of other brain regions to compensate. Over time, this means your brain is working harder just to make sense of what your ears are sending.
This reorganization happens gradually. It builds over years of untreated or undertreated hearing loss. And it doesn’t reverse automatically when you put hearing aids in.
Think of it like this. Your brain is a muscle. When it stops getting the right kind of exercise—clear, rich sound—it loses strength in the specific areas that handle speech. When you finally add hearing aids, sound rushes back. But your brain isn’t ready for it. It’s like returning to the gym after two years away. You can’t just walk in and lift what you used to. You have to rebuild.
This is why our brain health research consistently links untreated hearing loss to cognitive strain. The two problems share the same root cause: a brain that has been working too hard with too little input for too long.
The Five Listening Skills I See Decline
After treating thousands of patients, I’ve identified five specific skills that decline with hearing loss. These aren’t abstract concepts. They are the exact skills that determine whether you can function in real-world noise.
Skill 1: Understanding Speech in Background Noise
This is the most common complaint I hear. Quiet rooms feel fine. Restaurants feel impossible.
When your brain is deprived of clear sound for years, it loses the ability to separate a voice from background noise. The processing pathways that filter out what you don’t want and lock onto what you do want—those pathways weaken. Hearing aids help, but they can’t fully rebuild that filtering ability on their own.
Skill 2: Processing Rapid Speech
Fast talkers are hard for everyone. For someone with years of hearing loss, they can be nearly incomprehensible.
Your auditory processing speed slows down over time. The brain needs extra time to decode what it hears. When speech comes in faster than your brain can process it, words blend together. You catch the beginning of a sentence and miss the end. This happens even when volume isn’t a problem.
Skill 3: Separating Competing Voices
Thanksgiving dinner. A family reunion at the park. Multiple conversations happening at once.
A healthy auditory system can lock onto one voice and suppress others. This skill—called auditory streaming—weakens significantly with hearing loss. Your brain struggles to decide which voice to follow. The result feels like chaos, even when hearing aids are working correctly.
Skill 4: Auditory Working Memory
This is the skill nobody talks about, and it’s one of the most important.
Auditory working memory is your brain’s ability to hold one sentence in memory while the next one arrives. In normal conversation, you’re constantly doing this. You hold what was just said while you process what’s being said right now.
With hearing loss, this memory buffer weakens. You catch words but lose the thread. By the time your brain finishes processing one phrase, the next two are already gone. This is why conversations feel like hard work—they are cognitively demanding in a way that normal hearing is not.
Skill 5: Filling In Missing Words
Even with perfect hearing aids, you will occasionally miss a word. A healthy brain fills in the blank automatically using context.
“I drove my ___ to the grocery store.” Your brain knows exactly what fits. It does this without any effort.
But after years of hearing loss, your brain loses this automatic repair skill. When you miss a word, the whole sentence falls apart. You get stuck. You ask for repetition. The conversation stalls. This is one of the most fixable skills with proper training, and it makes an enormous difference in daily life.
Your Foundation Has to Come First: Real Ear Measurement
Here’s what I tell every patient before we talk about brain training. Your hearing aids have to be properly programmed first. Otherwise, you’re trying to rebuild a house on a cracked foundation.
To be blunt: most hearing aids are not programmed to the level of accuracy your ears need. Manufacturer software uses average ear canal data to guess what you need. But your ear canal isn’t average. It’s yours.
Real Ear Measurement changes this. We place a tiny probe microphone inside your ear canal. We measure what your hearing aids are actually delivering at your eardrum—not what the software predicts. Then we adjust until the output matches your specific hearing loss, frequency by frequency.
Real-ear probe microphone verification is widely considered the most accurate method for confirming hearing aids are meeting evidence-based targets at your eardrum. Without it, your provider is guessing. Patients with verified settings show better word recognition scores. The biggest gains appear at quiet and normal conversation levels—exactly where people with hearing loss struggle most.
If your provider has never used a probe microphone during your fitting, your hearing aids may be underperforming. That’s worth fixing before anything else.
You can read more about this in our article on why hearing aids fail patients who don’t get Real Ear Measurement.
How Brain Training Actually Works
Once your hearing aids are properly verified, auditory brain training gives your brain the structured practice it needs to rebuild the five skills described above.
Your brain can relearn. This is neuroplasticity—the documented ability of the nervous system to adapt based on what it’s exposed to. Research in auditory neuroscience confirms that the auditory system continues to reorganize throughout life. That works both ways. Deprivation causes decline. Structured input supports recovery.
The original LACE program was built on this principle. Sweetow and Sabes at UCSF developed it to address the gap between what hearing aids deliver and what the brain can do with that sound. Their foundational research showed statistically significant improvements in speech understanding, auditory memory, and communication function after structured home-based training.
That said, results across studies are mixed. Benefits depend heavily on how well hearing aids are fit first, how consistently patients practice, and whether they’re good candidates to begin with. That’s why I treat brain training like rehab — not a product add-on. Verified amplification comes first. Then structured practice. In the right patient, the combination produces results that amplification alone does not.
Think of it the same way you’d think about physical therapy after knee surgery. You wouldn’t get a high-quality replacement knee and then skip rehab. Without therapy, the muscles around the joint stay weak. ASHA guidelines are clear on this: outcomes improve when properly fitted hearing aids are combined with instruction, perceptual training, and support. Neither piece alone gets the full job done.
How LACE-AI Pro Rebuilds Each Skill
LACE is one of the better-known and more extensively studied home-based auditory training programs available. It has been evaluated in over ten clinical trials and is referenced in ASHA’s aural rehabilitation literature. The AI version adapts to your performance in real time. If you’re doing well, it gets harder. If you’re struggling, it backs off. It keeps your brain working at the right level of challenge—the growth zone where real learning happens.
Here’s how each training module targets the five skills:
Speech in Noise
The core training involves listening to target sentences while competing noise plays in the background. The difficulty adjusts based on how well you’re doing. Over time, your brain rebuilds the filtering pathways that allow you to lock onto one voice in a noisy room.
Rapid Speech Processing
Exercises present speech at progressively faster speeds. Your auditory processing speed picks back up. Fast talkers become manageable again.
Separating Competing Voices
Training includes tasks where two voices speak at once and you must follow only one. This directly exercises the auditory streaming ability that hearing loss weakens.
Auditory Working Memory
Exercises build your brain’s ability to hold sentences in memory while processing what comes next. This is one of the most immediately noticeable improvements patients report—conversations stop feeling like mental sprints.
Filling In Missing Words
This is one of my favorite features. You listen to sentences with an intentional gap. Your brain practices using context and memory to fill it in. Over time, this becomes automatic again.
One more thing worth mentioning: LACE-AI Pro allows you to upload recordings of your family members’ voices. You practice with the actual people you talk to every day—not generic narrators. That specificity matters in real-world transfer.
Published research confirms that structured auditory training generalizes to standardized clinical measures of speech-in-noise perception—meaning gains carry over into real-world listening, not just test booth scores. Brain imaging studies suggest neuroplastic changes occur with training. Individual results vary based on patient selection, fit quality, and consistency of practice.
When Brain Training Doesn’t Work
Auditory training isn’t right for everyone. Here’s when it tends to fall short.
When hearing aids aren’t properly fit first. This is the most common failure point. If your hearing aids aren’t delivering the right sound to begin with, you’re training on a bad signal. The brain needs accurate input. Fix the foundation first.
When training isn’t consistent. LACE-AI Pro works because it’s cumulative. A few sessions here and there don’t build the neural pathways the same way daily practice does. Patients who stop after two weeks rarely see the full benefit.
When cognitive decline is significant. Auditory training is a cognitively active process. Patients with moderate-to-severe dementia or significant memory impairment may not be able to engage with the tasks effectively. Hearing aids are still beneficial for these patients—but the active training component requires engagement that may not be possible.
When hearing loss is too severe for current devices. If someone has severe-to-profound hearing loss and their hearing aids aren’t getting enough signal to the brain in the first place, training can’t compensate. Those patients may need to explore cochlear implant evaluation before pursuing rehabilitation.
The patients who succeed most consistently are those who commit to daily sessions for at least four to six weeks and whose hearing aids were properly verified before they started. That combination is what produces results.
Hearing Care on the Wasatch Front
If you’re evaluating hearing care options in Utah, two questions will tell you more than any other: does this provider use Real Ear Measurement for every fitting, and do they offer structured auditory rehabilitation as part of follow-up care?
Most clinics along the Wasatch Front fit hearing aids. Fewer use Real Ear Measurement routinely. Fewer still include auditory rehabilitation as a standard part of their care model. When comparing providers in Salt Lake City, Murray, Sandy, Draper, South Jordan, or anywhere in Utah County, those two questions are the fastest way to separate adequate care from comprehensive care.
What to Look For in Any Provider
Real Ear Measurement should be non-negotiable. If a provider uses manufacturer first-fit software without probe microphone verification, your programming is based on averages—not your ear. That matters more than brand, price, or technology tier.
Auditory rehabilitation should be available and discussed at your fitting, not offered as an afterthought six months later when you’re frustrated. The sequencing matters: verification first, then rehab.
If you want help evaluating whether your current situation includes both, we can check two things quickly: whether your existing hearing aids are meeting evidence-based targets, and whether structured training is likely to help given your listening goals and hearing profile.
Get an Honest Assessment
Timpanogos Hearing & Tinnitus serves patients throughout Utah and Salt Lake Counties from our clinics in American Fork and Spanish Fork. Patients travel from Provo, Orem, Lehi, Pleasant Grove, and Springville for this level of care. We’re also expanding to better serve the Salt Lake Valley.
Schedule your free consultation—we’ll evaluate your hearing, check your current settings with Real Ear Measurement, and tell you honestly whether brain training makes sense for your situation.
Or call us at (385) 332-4325 to speak with our team directly.
Want to do more research first? Visit our Learning Center.
Common Questions About Brain Training
Can I do auditory brain training without hearing aids? You can, but the results will be limited. Auditory training works best when your brain is receiving clear, accurate sound to practice with. Without properly fitted hearing aids, the signal your brain trains on is incomplete. The two work together—devices provide the input, training rebuilds how your brain uses it.
How long does it take to see results from brain training? Many people notice early changes within a few weeks of consistent daily practice. Durable real-world improvement usually takes several weeks of regular sessions. Individual results depend on how well hearing aids are fit, how consistently you practice, and how long hearing loss went untreated before rehabilitation began.
My hearing aids are new. Do I still need brain training? Possibly. New hearing aids—even excellent, well-fitted ones—don’t automatically rebuild the listening skills your brain has lost. If you’ve had untreated or undertreated hearing loss for several years, your brain’s processing pathways have weakened. New devices provide the sound. Training helps your brain learn to use it. The two complement each other.
What if I’ve already tried auditory training and it didn’t help? The most common reason auditory training fails is that hearing aids weren’t properly verified first. If your devices weren’t fit with Real Ear Measurement, there’s a good chance your brain was training on the wrong signal. Start there. A proper verification and re-fitting often changes outcomes significantly.
Is LACE-AI Pro covered by insurance? Coverage varies. Some insurance plans and hearing benefit programs include auditory rehabilitation services. Our team can help you understand what your specific plan covers during your consultation. Many patients find the investment worthwhile regardless, given the improvement in daily communication.
Summary for Referring Clinicians
Physician Summary
Auditory rehabilitation outcomes in adult hearing aid users are measurably improved when device fitting is combined with structured perceptual training—a sequencing principle with consistent support in peer-reviewed literature and ASHA clinical guidelines. The gap between adequate amplification and functional communication in noise is well-documented; Real Ear Measurement verification closes part of that gap, but does not address the central auditory processing deficits that accumulate during years of auditory deprivation. LACE-AI Pro, built on a platform evaluated in over ten clinical trials, provides adaptive perceptual training targeting speech-in-noise processing, auditory working memory, and phonemic closure—skills that deteriorate with untreated hearing loss and do not recover through amplification alone. Patients presenting with complaints of noise difficulty despite current hearing aid use, or those with confirmed aided word recognition scores below expected levels, may be appropriate referral candidates; contact Timpanogos Hearing & Tinnitus at (385) 332-4325 in American Fork or Spanish Fork.
About the Author
Dr. Layne Garrett, Au.D., FAAA, ABAC, CH-TM, CDP is a board-certified audiologist and founder of Timpanogos Hearing & Tinnitus, with clinic locations in northern Utah. Over 20 years, he has specialized in tinnitus management, helping thousands of patients. Timpanogos Hearing & Tinnitus has been recognized as Best of State in Auditory Services 14 times and operates as one of only 14 Lenire Preferred Providers in the United States. His practice emphasizes patient education over sales-driven care.
Links: About | YouTube | Podcast | LinkedIn
Reviewed/Edited by: Dr. Layne Garrett, Au.D., FAAA, ABAC, CH-TM, CDP Date: March 23, 2026 3:30 PM MDT
